Healthcare Provider Details

I. General information

NPI: 1104057736
Provider Name (Legal Business Name): ROSS REHABILITATION P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 JEFFERSON ST NE SUITE E
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

7301 JEFFERSON ST NE SUITE E
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-341-0000
  • Fax: 505-341-1495
Mailing address:
  • Phone: 505-341-0000
  • Fax: 505-341-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number93-377
License Number StateNM

VIII. Authorized Official

Name: BARRIE WEINER ROSS
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 505-341-0000